国医大师张震基于“毒邪损络”辨治复杂性泌尿系感染经验

Chinese medicine master ZHANG Zhen's experience in treating complex urinary tract infections based on the theory of “toxin damaging the meridians”

关键词:  复杂性泌尿系感染  毒邪损络  分期论治  外治法  张震

Key words:  complex urinary tract infections  toxic pathogen damaging the collaterals  staged treatment  external therapy  ZHANG Zhen

摘要:

总结国医大师张震基于“毒邪损络”辨治复杂性泌尿系感染的临床经验。张震教授认为复杂性泌尿系感染的核心病机为毒邪侵袭、络脉受损，其中毒邪内蕴为发病之因，络脉瘀滞为致病关键，脏腑亏虚为复发之本。治疗时分期论治与标本兼顾相结合，治宜遵循解毒通络、扶正固本、调畅气机。急性期以解毒通络为主，根据湿热毒、瘀毒、热毒的不同，分别给予八正散合四妙散加减清热利湿，解毒通络；桃红四物汤合五味消毒饮加减活血化瘀，解毒通络；黄连解毒汤合银翘散加减清热解毒，通络止痛。缓解期以扶正固本为要，针对脾肾气虚、肝肾阴虚、气阴两虚证，分别采用补中益气汤合参苓白术散加减健脾益气，固摄膀胱；六味地黄丸合左归丸加减滋养肝肾，填精益髓；生脉散合玉屏风散加减益气养阴，固表止淋。恢复期以“一体两翼”为核心，以疏调气机为治法，以疏调汤为基础方，巩固疗效。同时治疗过程中配合中药坐浴奏解毒、通络、扶正之功，为复杂性泌尿系感染的中医诊疗提供新思路。

Abstract:

Summarize the clinical experience of Chinese medicine master ZHANG Zhen in treating complex urinary tract infections from the perspective of "toxic pathogen damaging the collaterals". Professor ZHANG Zhen posits that the core pathogenesis of complicated urinary tract infections involves toxin invasion and collateral channel impairment, wherein internal toxin accumulation serves as the causative factor, collateral stasis constitutes the critical pathological mechanism, and visceral deficiency underlies disease recurrence. In clinical practice, treatment strategies should integrate stage-specific differentiation with simultaneous attention to both the root cause and manifestations. Therapeutic principles should emphasize detoxification and collateral activation, reinforcement of healthy qi to consolidate constitution, as well as regulation and harmonization of qi dynamics. In the acute phase, the primary therapeutic strategy focuses on detoxification and collateral dredging. Based on distinct syndrome patterns-damp-heat toxin, static blood toxin, or heat toxin-tailored prescriptions are administered: Modified Bazheng Powder combined with Simiao Powder to clear heat, eliminate dampness, resolve toxins, and unblock collaterals; modified Taohong Siwu Decoction combined with Wuwei Xiaodu Yin to promote blood circulation, resolve stasis, detoxify, and dredge collaterals, and modified Huanglian Jiedu Decoction combined with Yinqiao Powder to clear heat, detoxify, unblock collaterals, and alleviate pain. During the remission phase, therapeutic emphasis is placed on reinforcing vital qi and consolidating the body's constitution. Specifically, for the patterns of qi deficiency of the spleen and kidney, yin deficiency of the liver and kidney, and deficiency of both qi and yin, tailored prescriptions are administered accordingly: Modified formulations of Buzhong Yiqi Decoction combined with Shenling Baizhu Powder are used to fortify the spleen and replenish qi, thereby consolidating the bladder's restraining function; modified Liuwei Dihuang Pill combined with Zuogui Pill are employed to nourish the liver and kidney, replenish essence, and supplement the marrow; while modified Shengmai Powder combined with Yupingfeng Powder are applied to tonify qi and nourish yin, strengthen the exterior, and alleviate lin syndrome. During the recovery period, the core principle is "one body, two wings", with the therapeutic method focusing on regulating qi flow. The basic prescription is Shutiao Decoction, which consolidates the therapeutic effect. During the treatment process, a traditional Chinese medicine sitz bath is used to detoxify, dredge meridians, and strengthen the body's vital energy. Provide new ideas for the diagnosis and treatment of complex urinary tract infections in traditional Chinese medicine.